Parathyroid disease is a collective term for conditions affecting the parathyroid glands. These conditions can be either benign (non-cancerous) or malignant (cancerous).
The parathyroid glands are responsible for producing Parathyroid Hormone (PTH), a crucial hormone that regulates the levels of calcium and phosphorus in the bloodstream. PTH is vital for maintaining healthy bones, reducing the risk of kidney stones, and preserving kidney function.
There are typically four parathyroid glands, situated in the neck, close to the thyroid gland. Each gland is usually about the size of a kernel of corn. Generally, there is one parathyroid gland located near each corner of the thyroid. In some individuals, one gland may be missing, or there may be an extra one. Others may have parathyroid glands in unusual locations in the neck or chest; however, these glands can still function normally.
Parathyroid disease develops when a parathyroid gland produces either too much or too little PTH, or when a parathyroid cell undergoes a mutation and becomes cancerous. The main types of parathyroid disease include:
This condition occurs when the parathyroid glands secrete an excessive amount of PTH. In the majority of cases, this is caused by an adenoma, which is a benign tumour, on one of the glands, leading to overproduction of PTH. Approximately 20% of patients have all four glands enlarged and producing too much PTH. Excess PTH can result in abnormally high levels of calcium in the blood, a condition known as hypercalcaemia. This can lead to serious health issues such as osteoporosis (weakening of the bones) and kidney stones.
Cancer of the parathyroid glands is exceptionally rare. While parathyroid cancer can sometimes cause hyperparathyroidism, it affects less than 1% of individuals with hyperparathyroidism. Men and women have an equal risk for this type of cancer, which typically affects people in their 50s. Although parathyroid cancer progresses slowly, it often recurs after initial treatment, returning to the original site in the neck. On average, the cancer returns about two and a half years later.
This is a rare condition where the body does not produce sufficient PTH, leading to abnormally low levels of calcium in the blood. It most commonly occurs following surgery for another condition, such as thyroid surgery.
A risk factor is anything that increases your chance of developing a particular disease. Risk factors for parathyroid disease include:
Women over the age of 50 have an increased risk of developing hyperparathyroidism.
Having certain inherited disorders, such as familial isolated hyperparathyroidism (FIHP) and multiple endocrine neoplasia, can increase the risk of developing parathyroid cancer.
In the early stages, parathyroid disease often presents with no symptoms. When symptoms do occur, they vary from person to person and depend on the specific type of disorder.
Low energy
Fatigue
Loss of appetite
Muscle weakness
Bone or joint pain
Constipation
Anxiety or depression
Kidney stones
Bone loss (osteoporosis)
Broken bones
Hypertension (High blood pressure)
Heartburn
Insomnia/difficulty sleeping
Bone pain and broken bones
Kidney stones
Long-term increase in blood calcium levels (hypercalcaemia)
Muscle weakness
Fatigue, drowsiness
Urinating more than usual
Constipation
Depression
Nausea and vomiting
Loss of appetite
Lump in the neck (rare)
Difficulty speaking or swallowing
Numbness and/or tingling in the fingers, toes, or around the mouth
Severe muscle cramps or spasms to the point of being immobile (a rare symptom that requires emergency medical attention)
An accurate diagnosis is the essential first step in successfully treating parathyroid disease. As it is a rare condition, diagnosis can be challenging, making it important to consult a doctor with experience in recognising it. Our endocrinologists and pathologists at SSCHRC specialise in the diagnosis and treatment of parathyroid disease, being among the most experienced and skilled in the nation.
The following tests are commonly used to diagnose these conditions and/or to monitor a patient's response to treatment:
These tests check for the levels of calcium, vitamin D, and parathyroid hormone in the blood.
Doctors measure the amount of calcium present in the urine.
These may include:
If you are diagnosed with parathyroid disease, your doctor will discuss the best treatment options with you. The approach is customised to your specific needs and depends on factors such as the type of disease and your overall health. One or more of the following therapies may be recommended to treat the cancer or help relieve symptoms.
Treatments for hyperparathyroidism include the following:
Surgical removal of the parathyroid gland where the tumour is located is the main treatment for primary hyperparathyroidism. This procedure, called a parathyroidectomy, is typically performed as outpatient surgery. Surgeons may use two main approaches:
Medication may be prescribed to reduce parathyroid hormone levels and control calcium levels in the blood. While this is an option for some, surgery is often considered better for long-term control of the condition for many patients.
Treatments for parathyroid cancer include the following:
The primary treatment for parathyroid cancer is a parathyroidectomy. During this procedure, the surgeon makes a small incision in the neck and removes the cancerous gland along with any surrounding tissue that may be affected by the cancer.
Targeted therapy drugs are specifically designed to stop or slow the growth or spread of cancer at a cellular level. Cancer cells need specific molecules (often proteins) to survive, multiply, and spread. Targeted therapies are designed to interfere with, or target, these molecules or the cancer-causing genes that create them. Targeted therapies have been evaluated in clinical trials and have shown some success in treating parathyroid cancer.
Medication may be prescribed to reduce the high calcium levels that result from elevated levels of parathyroid hormone. These can be administered orally or through injections.
Radiation therapy employs powerful, focused beams of energy to destroy cancer cells. Various radiation therapy techniques are available, allowing doctors to accurately target a tumour while minimising damage to healthy tissue. Radiation is seldom used directly on the parathyroid glands but can be used on parathyroid cancer that has spread to the bone.
Patients with hypoparathyroidism may be prescribed medication to help increase their parathyroid hormone and calcium levels.